20.500.12556/RUL-178069 Učinek preddvorno-prekatne optimizacije z elektrostimulacijo Hisovega snopa na zdravljenje preddvorno-prekatne dromotropatije ​Impact of atrio-ventricular optimisation with His bundle pacing on treatment of atrio-ventricular dromotropathy Preddvorno-prekatna (ang. atrioventricular, AV) dromotropatija označuje simptomatski prvostopenjski AV blok zaradi mehanske AV neusklajenosti. Smernice dopuščajo zdravljenje teh bolnikov s srčnim spodbujanjem, vendar so dokazi omejeni zgolj na opise posameznih kliničnih primerov. Na Kliničnem oddelku za kardiologijo Univerzitetnega kliničnega centra v Ljubljani smo zasnovali prospektivno navzkrižno raziskavo z namenom preučitve vpliva električnega spodbujanja pri bolnikih z AV dromotropatijo. V prvem delu naloge smo primerjali stalno AV-optimizirano spodbujanje s podpornim načinom spodbujanja, pri katerem so bili bolniki v lastnem ritmu z dolgim intervalom PR. Ocenjevali smo prisotnost simptomov, telesno zmogljivost in hemodinamične ehokardiografske parametre v obdobjih enega in drugega načina spodbujanja. Telesno zmogljivost smo objektivno opredelili z maksimalno stopnjo obremenitve in maksimalno porabo kisika. Med ehokardiografskimi parametri smo primerjali utripni volumen levega prekata, prisotnost mitralne regurgitacije, diastolično polnitev ter velikost in funkcijo levega prekata in preddvora. Za objektivnejšo oceno simptomov so bili bolniki slepi za obdobji spodbujanja. V drugem delu naloge smo ocenjevali pomen mehanske AV neusklajenosti pri izbiri bolnikov za zdravljenje z elektrostimulacijo. Pri tem smo se oprli na dve raziskavi drugih centrov, izvedeni z računalniško simulacijo oziroma pri bolnikih s prvostopenjskim AV blokom in srčnim popuščanjem z znižanim iztisnim deležem. Opravili smo podanalizo osnovne raziskave AV dromotropatija in ocenili prognostični pomen elektrokardiografskih in ehokardiografskih kazalnikov AV neusklajenosti. V zadnjem delu naloge smo analizirali podatke iz prospektivnega registra bolnikov z izrazitim prvostopenjskim AV blokom (interval PR > 300 ms). V petletnem spremljanju smo ocenili pojavnost napredovanja AV bloka pri teh bolnikih in skušali prepoznati napovedne dejavnike za napredovanje bolezni. Atrioventricular (AV) dromotropathy refers to symptomatic first-degree AV block due to mechanical AV dyssynchrony. Current guidelines allow for the treatment of these patients with cardiac pacing; however, the evidence is based solely on case reports. At the Clinical Department of Cardiology at the University Medical Centre Ljubljana, we designed a prospective cross-over study to investigate the effects of electrical stimulation in patients with AV dromotropathy. In the first part of this thesis, we compared continuous AV-optimized pacing with a back-up pacing mode, in which patients remained in their intrinsic rhythm with a prolonged PR interval. We assessed the presence of symptoms, exercise capacity, and hemodynamic echocardiographic parameters during each stimulation period. Exercise capacity was objectively defined by maximal workload and peak oxygen consumption. Echocardiographic parameters included left ventricular stroke volume, presence of mitral regurgitation, diastolic filling parameters, and the size and function of the left atrium and left ventricle. To ensure an unbiased symptom assessment, patients were blinded to the pacing periods. In the second part of the thesis, we evaluated the role of mechanical AV dyssynchrony in selecting patients for pacing therapy. This appraisal was based on two studies conducted at other centers using computational simulations or involving patients with first-degree AV block and heart failure with reduced ejection fraction. We performed a subanalysis of the primary AV dromotropathy study, examining the prognostic significance of electrocardiographic and echocardiographic markers of AV dyssynchrony. In the final part of the thesis, we analyzed data from a prospective registry of patients with severe first-degree AV block (PR interval > 300 ms). Over a five-year follow-up period, we assessed the incidence of AV block progression in these patients and attempted to identify predictors of disease progression. atrio-ventrikularni blok prve stopnje atrio-ventrikularna neusklajenost preddvorno-prekatna neusklajenost stimulacija prevodnega sistema stimulacija Hisovega snopa elektrostimulacija srca first-degree atrioventricular block atrioventricular dyssynchrony conduction system pacing His bundle pacing cardiac pacing true false false Slovenski jezik Angleški jezik Doktorsko delo/naloga 2026-01-17 07:15:07 2026-01-17 07:15:22 2026-01-23 10:44:00 0000-00-00 00:00:00 2026 0 0 0000-00-00 NiDoloceno NiDoloceno NiDoloceno 0000-00-00 0000-00-00 0000-00-00 38460 8504.pdf 8504.pdf 1 4E6AD63C0A325CD8572004DB7437D17F b3126f1a930df32163752042711470676359c649ffc6cc993e9d3baf9a30f4aa dd0fab4b-f36b-11f0-bf92-0050569b8976 https://repozitorij.uni-lj.si/Dokument.php?lang=slv&id=225602 Medicinska fakulteta 0 0 0